presyncope; near-syncope

Introduction

Presyncope is a feeling of faintness without loss of consciousness (not true syncope) generally associated with cardiovascular disease.

Etiology

• cardiac
  • usually accompanied by other symptoms
    • chest pain
    • shortness of breath
    • dyspnea on exertion
  • valvular disease (aortic stenosis)
  • hypertrophic obstructive cardiomyopathy
  • low cardiac output
  • arrhythmias
• vascular
  • more common than cardiac causes
  • generally benign
  • vasovagal response (most common)
  • medications
  • dysautonomia
  • decreased baroreceptor sensitivity associated with aging

Pathology

diffuse cerebral ischemia

History

• medications, especially:
  • phenothiazines
  • nitrates
  • alpha-1 blockers
• symptoms of cardiovascular disease

Physical examination

• orthostatic blood pressure
• auscultation for cardiac murmurs

Clinical manifestations

• perspiration
• pallor
• palpitations
• feeling of faintness
• no loss of consciousness

Laboratory

• electrocardiogram (EKG)
• echocardiogram
• chest X-ray
• Holter

Management

• depends upon the underlying disorder
• treat as syncope in the elderly

More general terms

• dizziness

Additional terms

• syncope